Could Virtual, Augmented Reality Augment Medicine?

Demos at Newseum event suggest where technology is headed

WASHINGTON -- Sarah Murthi, MD, stood between an ultrasound monitor and a University of Maryland student supine on a medical bed at the Newseum here. Clad in a pink scrub, the University of Maryland School of Medicine trauma surgeon demonstrated a new way to view ultrasound images as a dozen or so onlookers stared and occasionally chuckled. One by one, audience members donned goggles to see images from inside the student for themselves.

Murthi was one of a handful of practitioners who demonstrated augmented reality and virtual reality technologies for medicine at Newseum VRMeets: Health and Medicine Monday evening. They exhibited these technologies' roles in trauma, psychiatry, and neurosurgery -- as well as sports psychology and pain management.

Augmented reality superimposes digital information on top of a natural sensual experience; the now terminated Google Glass was an early application. Virtual reality creates an immersive simulated environment in which, for example, turning one's head around causes the imagery to turn as well, and it can be displayed in 3-D.

While speakers at the event extolled the technologies and predicted widespread medical implementation one day, they were careful to note they are not advocating for either version of reality to replace real practitioners. "This is an additional tool," University of Southern California computer scientist Arno Hartholt said of a virtual reality program for treating psychiatric disorders that he works with. "The tool still needs clinician guidance."

Outside the studio, Ben Barone, MA, demonstrated a system he uses to show elite athletes their nervous system activity on a monitor in real time, to prepare them for competition. Observers donned measurement devices on their fingers and placed fingers on their neck to feel their pulse, while viewing their heart rates and breathing patterns. This is heart rate variability biofeedback, which promotes both parasympathetic and sympathetic nervous system activity, said Barone, co-founder of Coresights.

Neil Martin, MD, neuroscience director at Geisinger Health System in Pennsylvania; Hunter Hoffman, PhD, a cognitive psychology research scientist with the University of Washington; and Hartholt demonstrated and spoke about their work with augmented and virtual reality for:

Simulated brain surgery

Distracting burn victims from feeling pain during typically painful procedures by placing them in a virtual world

Exposure therapy to treat PTSD and anxiety disorders

Augmented and virtual reality can help train residents and students, connect experts with medical personnel in the field or operating room ("like a 3-D reconstruction of telemedicine," Murthi said), and rehearse procedures on simulated patients as opposed to live ones, these exhibitors said. They can also be leveraged to help patients understand treatment options.

Take the work of Murthi and Amitabh Varshney, PhD, a computer science professor at Maryland. Murthi and colleague Caron Hong, MD, demonstrated how augmented reality can be applied to ultrasounds and intubation. While Murthi showed how to view ultrasound data directly on the Maryland student-turned-patient without having to turn away, Hong coached volunteers as they donned large goggles and peered into a portioned medical dummy (head and neck only) via an inserted intubation tube to view the inside of a dummy trachea.

In practice, the goggles allow multiple people to see the same image without breaking communication or adjusting their head -- critical in trauma centers, Hong said. The technologies should allow practitioners to multitask more efficiently in trauma centers, while merely adding one piece to established medical practices. (And not replacing practitioners, Murthi said.)

"We're really at the very beginning of this field," Martin said. Quality checks are being adjusted and many risks have not even been defined, he said. "There's going to have to be a much higher level of evidence required" before virtual reality is reimbursed in medicine.

Addressing another potential problem, Hong said she "absolutely" worries that practitioners could be overstimulated by such technologies. (Users of virtual reality games have reported feeling nauseated, for example.) Training should help, she said. Hong, a critical care anesthesiologist, became comfortable using the intubation tube over one weekend.

Many augmented and virtual reality medical tools still need FDA approval, regulations and venture capital before becoming clinically available. Murthi said the Maryland group's augmented reality tools, for example, could be ready within a year, but companies are skittish and don't foresee enough return on their investment to dive in as aggressively as they are funding virtual reality in gaming.

"Within one year, it will be available in some format," Murthi said. "How it will take hold is harder to tell."

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